Hello and welcome back to Making Sense of Women's Health. I'm Roberta Bass and I'm a Women's Health Physio, Pilates instructor, menopause mentor and the founder of Thrive and Shine Women's Wellness. So today's episode covers a really important topic and that is pelvic health red flags. Now these are symptoms that might indicate an underlying medical issue and things that should not be ignored.

Some could be related to benign conditions, but others may warrant further investigations or some even urgent medical attention. So my aim is today to help you understand what to look out for, when to seek medical advice and where physio or other holistic support might be appropriate if the cause turns out to be something that's not serious, but it is still impacting your quality of life.

So let's start by outlining some of the key signs that can require attention. First of all, vaginal bleeding after menopause, bleeding between periods, bleeding after sexual intercourse, persistent or unexplained bloating, new or ongoing pelvic pain, pain during intercourse, changes in bladder or bowel habits, loss of bladder or bowel control, numbness in the saddle area, unexplained weight loss or unusual vaginal discharge. Now these symptoms don't always mean something serious is wrong but they do indicate that a medical review is appropriate. I'm going to take a little bit of a closer look at each one to explain why they may be problematic and what they might indicate.

So first of all postmenopause bleeding. So any vaginal bleeding that occurs 12 months or more after your final period when you are officially postmenopause is considered abnormal and must be assessed by a GP. So you need to go and get it checked out. Sometimes when we hit menopause it might be that you've gone 10 or 11 months and then you have a period but if you are officially postmenopause and you've gone at least 12 months then it needs to be checked out by the GP. things that could be causing this is thickening of the womb lining, polyps or the most serious thing is endometrial or cervical cancer and those are the things that need checking out.

So if you go to the GP, normally what happens is you get put on a two week wait, certainly in the UK, means that you should be seen by a specialist being referred in, getting scans and things within the two weeks, just to rule out any serious issues. What often happens is you get everything ruled out and you're left to get on with it with no answers as to why you're actually getting that bleeding.

But things that could be causing it are vaginal atrophy. So this is where we get thinning of the vaginal tissues and this can cause micro trauma and cause bleeding from that. It could be a side effect if you are taking HRT and it also could be issues with cells within the cervix that grow on the outer lining of the cervix that then cause bleeding, not necessarily something that is a sinister.

so it's not cancer but it just can be that they are growing where they shouldn't be. Now it's really important like I say for your GP to refer you on so whatever the cause we need to make sure that it's nothing serious. So once you've had the scans and you might have like a camera put up inside if they're not sure, if then the cause is benign there are other things that we can do for those other things which we'll go through at the end.

Now if you are still having a regular cycle and you are getting bleeding either between periods or after intercourse then this could be signs of changes to the cervical area so that could be abnormal cells which could be cancerous or pre-cancerous. It could be polyps. So little benign growths that grow around that area. It could also be down to hormonal fluctuations, particularly if you're going through perimenopause. It might be that you're just getting really irregular periods. So it's a job to know whether it is in between your cycle or whether it is just another cycle that's happening.

Fibroids can also cause problems. So these are growths within the uterus itself. They can cause heavy bleeding, but they can cause bleeding outside of your normal menstrual cycle. And again, if you are postmenopausal or perimenopausal and you're getting some dryness or some vaginal atrophy, that again can cause bleeding. So particularly after intercourse because of that friction that can cause that micro trauma and some bleeding.

Could also mean that you've got an infection or that you have some abnormal cancerous cells. So it's really important that again you are getting that looked into, getting an assessment from the GP, make sure that you are up to date with your smear test. If it's been a while maybe going to get another one. It might be that they do some swabs or some scans to rule out if there's any infection.

Another thing that could be causing issues is bloating or feeling of fullness within the abdomen or the pelvic area. Now, occasional bloating is common. So if you're eating particular foods that aren't agreeing with you, or during your period, we often get bloating or different times of the month, or again, during perimenopause, there's lots of digestive issues that can happen. However, bloating that occurs on a frequent basis and doesn't resolve may need to be investigated further. Particularly if this is related to feeling full quicker, after eating, if you're needing to urinate more often, if you're getting any unexplained weight loss.

This could indicate that you have ovarian cancer.

If you are getting it irregular then it might be other conditions such as irritable bowel syndrome, it might just be your digestion isn't great and you're getting constipation or it might be that you are allergic to certain foods that you need to be avoiding. But it's a good idea particularly if you're getting consistent bloating and it coincides with that fullness and that you don't want to eat as much and you are losing weight, then go and see the GP because they can arrange some blood tests, they can arrange ultrasounds just to rule out anything serious going on.

If you are getting pelvic pain, this could be caused by number of different problems. So it could be gynae issues, it could be fibroids, it could be that it's down to the bowels and you're getting IBS. It could be due to overactive bladder and issues with your pelvic floor. It could also be musculoskeletal. It could be the pelvic joints. It could be referred from the back. But if you are getting sudden severe pain that worsens and isn't getting any better, or it is related to bleeding, so vaginal bleeding or a fever, it could be that you've got a pelvic infection.

It could also be other things like endometriosis, but you would expect that to be kind of cyclical in nature, might get worse as time goes on. It might be that you've got issues with an ovarian cyst or ovaries themselves, particularly if cysts burst that can be extremely painful. It might be that you're getting bladder or bowel issues or conditions. It might be pelvic floor dysfunction, so overactivity of the pelvic floor. If you're getting that severe pain and it coincides with other symptoms such as a vaginal discharge, then it may well be that it is an infection and that needs to be looked at quickly.

But if you are getting any of these other symptoms, it's still a good idea to check with the GP, rule out anything else from any swabs, any pelvic imaging or blood tests. If then it turns out that the pelvic floor is the underlying cause or it's down to postural issues, then physio is going to be your best way to manage that.

Pain with intercourse, so we've already mentioned a couple of causes of say bleeding after intercourse and pain can be related to pelvic floor issues. It can be down to dryness that causes some micro trauma during intercourse. But if it is new or increasing, don't just dismiss it. Yes, it can be down to dryness, particularly after menopause, or it could be down to pelvic floor. But it also could be things like endometriosis, or as we mentioned before, it could be infections. Again, it's worth getting an examination from your GP just to rule out any of those other underlying causes.

But again, if it's down to pelvic floor issues, that is definitely something that I help with because we need to sort out any overactivity, do some relaxation. It might be down to problems like prolapse. Again, even with vaginal dryness, using some lubrication, using some moisturisers can be really helpful to improve that discomfort. If it's a sudden change then it's always worth getting checked out and if it coincides also with having the discharge, if there's any sign of infection or anything else that I've mentioned previously then definitely go and get it checked out.

If you notice any changes, sudden changes to your bladder and bowel function as well, is also worth taking note of what's going on. Things like increased urination or frequency, leaking of your urine, they could be linked to pelvic floor issues but also to bladder infections. It might be if you're having issues with emptying or you're getting constipation, or you're leaking stool, or if you are getting blood in your stool or when you wipe, then you need to get that all looked into.

It might be that you are emptying the bowels, but still feel like there is something there. Or if you've got changes in the consistency of your stool. Now, this is going to change when we're eating different foods as well. It might be if you're eating more greasy foods or you've had something that doesn't agree with you, but it is that ongoing change or a sudden change if it's related to some blood in the stool as well, then it's definitely worth getting it checked out to ensure that it's not bowel cancer. That's obviously the most serious thing it could be.

But it also could be inflammatory bowel disease or it might be that you're just getting some hemorrhoids. We might know that it's piles, they become inflamed or it might be fissures. You may be getting changes due to perimenopause or menopause which can change how you digest food or cause you to have intolerances of certain foods. But also it could be pelvic floor dysfunction again, or a prolapse.

So it's really important just to know if there's any changes to your bladder or bowel, what's going on, is it related to anything else, if there's any blood in either area that's not normal for you. So it's outside of periods, if you're postmenopausal, if you're getting any blood when you're wiping or in the stool itself, then you need to go and speak to the GP. That's fairly straightforward tests they can do on your bowels to make sure there's nothing sinister. They might give you blood tests, but if you've had any alterations for more than about three weeks, then you definitely need to get it checked out.

So as a one-off thing, it might be due to other reasons. It might be that you've been straining. It might be that you're a bit constipated, but if it's ongoing, get it checked out. If again, it's down to pelvic floor dysfunction, or you're straining to empty, that's certainly things that I can help with. So we reduce the constipation, we address any tightness that might be causing constipation. It might be we need to change what you're eating, what you're drinking to help with the consistency of the stools as well.

Another thing that changes in bladder and bowel could relate to is more of a muscular skeletal thing, is actually problem with the back itself and the nerves, particularly if you're getting a loss of sensation in your saddle area. So imagine if you were sat on a horse, it would be the area between the legs that would be touching that saddle, which is why we call it the saddle area.

Now, if you're getting numbness or pins and needles there, if you're getting difficulty, emptying the bladder, so you're what we call retention, so you find it difficult to actually fully empty, or you're getting incontinence of the bowels. This could all suggest a condition called cord or equina, where the nerves at the base of the spine are getting compressed. It normally coincides with back pain as well. And it can be pain down both legs. And it can be issues with walking as well so you're getting some weakness in your legs as well.

If you're getting those symptoms so back pain, bladder and bowel issues, numbness between the legs, some weakness, that is a medical emergency and you need to go to A &E or call for an ambulance because we need to decompress the nerves at the base of the spine otherwise it could cause permanent damage. So if you're getting those symptoms whether you're getting long term back pain and these develop or whether it's a sudden onset and you're getting these bladder and bowel issues, leg symptoms, it just needs to be looked at immediately. It is an emergency. You need to go and get it sorted.

So a lot of times when I'm treating people for their back pain, I always screen for this and in pregnancy as well, then it's always important to be aware of this.

We've already mentioned discharge. So it is normal for a woman to have vaginal discharge and it changes throughout the month. It can get thicker, it changes colour slightly. But if it is green or grey or it's blood stained or has a really strong odour or if there's itching or pain or irritation, that may indicate an infection. It may also be down to the changes at menopause where we get some atrophy, but also like a change in pH or if you're then using some kind of pessary medication, it might change things or if you're on hormonal contraception or if you've got a coil, it might change things.

But if you're getting foul smelling, if you're getting a lot more of it and it is changed to colour, then it's worth getting the GP just to swab to see if there's anything else going on.

Now, I've mentioned as we've gone along that a lot of these things turn out to be benign, meaning no serious pathology, no serious thing going on in the background. That is obviously the main thing that we need to think about. So we want to make sure that there's nothing serious going on and that we're actually covering all bases. Get that cleared out.

But it doesn't mean that when they say all is okay, and you're just dismissed and like, get on with it doesn't mean you have to then put up with it. Things like leaking bladder, prolapse symptoms, the vaginal dryness, pain during intercourse, they can all affect your quality of life. And oftentimes, once they've ruled out anything sinister, they just kind of leave you to get on with it.

But there is a lot that can be done. And as a women's health physio, those are the kinds of things that I treat. So the bladder and bowel dysfunction, pelvic pain and recovery after childbirth or any gynae issues. And the symptoms that are caused by menopause and hormonal changes.

Things that I might then suggest that we do is working on your pelvic floor, making sure you're getting moving, changing any postural issues. Might be that we get in doing hands-on treatment if there's any issues with muscles or joints. It might be that you need to change some of the things that you're eating or drinking or looking at your sleep or your stress management because that can change your hormonal balances.

And as I've mentioned, particularly postmenopausal, then it might be that a vaginal moisturiser is the answer to stopping you from having some vaginal bleeding and any pain within intercourse and using that lubrication. That can be really helpful. Making sure you're drinking plenty and that's gonna support your bladder and your bowel function. Make sure that you're not straining when you're emptying your bowel because that's gonna help reduce any hemorrhoids and reduce bleeding from those if you're getting it.

But if something doesn't feel right, then speak to your GP. I know it's difficult to get a GP appointment, so certainly if things are ongoing and not settling, it is always worth getting in to see them because early intervention can make a real difference if there is anything underlying that's more serious.

But if you want to learn more about some of the more benign conditions such as menopause, prolapse, and cervical health, I've covered a lot of those conditions in previous podcasts.

And if you want to find out more or want to book to have an appointment with me, then visit the website, is thrive and shine, womens wellness.co.uk. The link is in the show notes.

I have lots of different services that may be appropriate to you, or you can send me an email to see if it's something that I can help you with.

Thank you for listening today, and I hope this episode has made you feel more informed and confident about what to look out for and what support is available and when you need to seek help.

And next week I will be sharing some practical ways to make exercise a consistent part of your week, especially if you are navigating through midlife fatigue, joint pain or hormonal changes. But until then, take care of yourself and remember you don't have to wait until things get worse to ask for help.

Take care and see you next time.